Abstract :
Background: The incidence of proximal femoral fractures are markedly increasing because of increasing life expectancy and motor vehicle accidents. Subtrochanteric fractures of femur pose a great problem because of diversity of fracture patterns and difficulty in attaining anatomical reduction and also it is high stress region, having less vascularity. Intramedullary fixation devices like PFN is technically demanding and many times it needs open reduction of fractures. Favourable mechanics is attained by flexible intramedullary nailing like Ender’s nailing.
Materials and Methods: This is a comparative study of 40 cases of subtrochanteric fractures of femur, out of which 20 treated with Ender’s nailing and other 20 treated with PFN. All were closed fractures. Age was ranging from 20 to 70 years. In our study patients distribution according to Frank- Seinsheimer classification was as follows… Type I – Nil, II A – 1 pt., II B – 6 pts., II C – 1 pt., III A – 11 pts., III B – 6 pts., IV – 7 pts., V – 8 pts. In PFN open reduction was done in 5 pts., while in Ender’s nailing all pts. were managed by close reduction.
Results: Average union time was 18 weeks in PFN, while 15 weeks in Ender’s nailing. Reoperation due to implant breakage and/or Z-effect was required in two cases in PFN. Shortening upto 1 cm. seen in 2 pts. in PFN, while in Ender’s nailing upto 1 cm. in 6 pts. and from 1 to 2 cm in 2 pts.
Conclusion: In obese pts. Ender’s nailing is easy, while PFN is more technically demanding. Union is earlier in Ender’s nailing v/s PFN. PFN is more stable implant. Excellent or good results are seen in 15 out of 20 pts. in PFN, while 18 out of 20 pts. in Ender’s nailing.
Keyword :
Ender’s nailing, PFN, Subtrochanteric, Femur.